Endoscopic Endonasal Surgery for Resection of Cranial Base Epidermoid and Dermoid Cysts: Advantages and Limitations

Introduction: Endoscopic endonasal approaches (EEA) are rarely used for resection of cranial base epidermoid and dermoid cysts. These lesions tend to spread along the subarachnoid cisterns and adhere to the surrounding neurovascular structures. The aim of this study is to describe our experience with EEA for intracranial resection of these types of lesions, emphasizing their advantages and limitations.

Methods: The patient database of the Center for Cranial Base Surgery at our institution was searched for all endoscopic endonasal procedures devoted to the removal of epidermoid and dermoid cysts. Retrospective chart review and updated clinical consultations were performed for data collection.

Results: From January 2005 to January 2013, 18 patients (11 male, 7 female) with a mean age of 25.6 years (2–60) were identified. There were 9 epidermoid and 9 dermoid cysts. Vision loss was the most common clinical presentation (7 patients). The cysts were mainly located at the suprasellar cistern (8 patients). The transplanum approach was used in 8 cases, transfrontal in five, transclival in three and transpterygoid in two cases. Total resection was achieved in 7 patients, subtotal in 8 and partial in 3. Postoperative CSF leak was observed in four patients. Postoperative infection was observed in four patients and was related to non-total resection. Surgical outcome was considered good in all but two patients.

Conclusions: EEA may be safely and effectively performed for resection of epidermoid and dermoid cysts. Improved visualization allows for safer cyst resection. Significant residual (larger than 1 cm) correlates with postoperative infection.